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Neurology (Expert Forum)
Grade II Astrocytoma- treatment
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Grade II Astrocytoma- treatment
by leedee, Mar 25, 2007 12:00AM
My husband (30 years old) was diagnosed with a low-grade, ill-defined, astrocytoma this past week. It is about 9 mm in size and in the area is his left temporal and occipital lobe. The neurosurgeon suspected that it has been present for a few years now. He feels that it is not putting pressure on the brain at this time. My husband has started Lamictal due to very mild seizure-like symtoms (disorientation, tunnel vision--which went away prior to the medication). We were informed that the tumor is not amenable to removal due to its location and that a biopsy is risky. The "wait and see" approach was recommended.
I have a few questions, 1) are there other treatment options that can help reduce it's size at this time rather than simply "waiting and seeing?" 2) would this be amenable to the Gamma Knife treatment? 3) are there any other recommended credible approaches (diet, home therapies, etc)that we can start putting in place? 4) without surgery, is it possible to beat this tumor?
Thank you greatly for your advice.
I have a few questions, 1) are there other treatment options that can help reduce it's size at this time rather than simply "waiting and seeing?" 2) would this be amenable to the Gamma Knife treatment? 3) are there any other recommended credible approaches (diet, home therapies, etc)that we can start putting in place? 4) without surgery, is it possible to beat this tumor?
Thank you greatly for your advice.
Doctor's Answer
by Forum-M.D.-SH, Apr 13, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
I am sorry to hear about your husbands diagnosis. Low grade astrocytomas are often difficult lesions to address, but as far as brain tumors are concerned are much better than the alternatives (such as glioblastoma etc). One difficult problem with astrocytomas is that the are diffusely infiltrative (extend little fingers of cells far from the 'margins' of the tumor) and often can never be fully resected (they often recurr even with large resections). This become even more of a problem in areas of the brain that are highly functional. The left temporal lobe is responsible for language including hearing and understanding language, speaking language as well as memory, emotions etc. Losing the left temporal lobe can often leave a patient disabled (while the loss of the right temporal lobe is often better tolerated). The next step for you would likely require a biopsy (a stereotactic biopsy can be planned to spare vital functions and is minimally invasive). The reason I stress the biopsy is that there are many tumors that can look like a 'low grade astrocytoma'. One such tumor is an oligodrendroglioma, which is important to indentify because it responds well to chemotherapy. Others include gangliogliomas and DNETs, which are slow growing and are unlikely to turn into more aggressive forms of brain cancer (but are frequent causes of intractable epilepsy). It is also important to identify if the tumor is infact an astrocytoma, since they occur in multiple stages and have the potential to transform into a more serious type of tumors (such as glioblastoma). Gamma knife therapy has been used for some tumors, but his depends on multiple factors and I would recommend that you speak with a neurosurgeon at a major academic center, so that he can review your films and case to determine if your would be a good candidate. I do not know of any credible diet/alternative therapies that have proven benefit for brain tumors. Your success against the tumor can be positively affected by establishing a team that you trust of doctors, support personnel and family members that will help you through this tough time.
I hope this has been helpful.
I am sorry to hear about your husbands diagnosis. Low grade astrocytomas are often difficult lesions to address, but as far as brain tumors are concerned are much better than the alternatives (such as glioblastoma etc). One difficult problem with astrocytomas is that the are diffusely infiltrative (extend little fingers of cells far from the 'margins' of the tumor) and often can never be fully resected (they often recurr even with large resections). This become even more of a problem in areas of the brain that are highly functional. The left temporal lobe is responsible for language including hearing and understanding language, speaking language as well as memory, emotions etc. Losing the left temporal lobe can often leave a patient disabled (while the loss of the right temporal lobe is often better tolerated). The next step for you would likely require a biopsy (a stereotactic biopsy can be planned to spare vital functions and is minimally invasive). The reason I stress the biopsy is that there are many tumors that can look like a 'low grade astrocytoma'. One such tumor is an oligodrendroglioma, which is important to indentify because it responds well to chemotherapy. Others include gangliogliomas and DNETs, which are slow growing and are unlikely to turn into more aggressive forms of brain cancer (but are frequent causes of intractable epilepsy). It is also important to identify if the tumor is infact an astrocytoma, since they occur in multiple stages and have the potential to transform into a more serious type of tumors (such as glioblastoma). Gamma knife therapy has been used for some tumors, but his depends on multiple factors and I would recommend that you speak with a neurosurgeon at a major academic center, so that he can review your films and case to determine if your would be a good candidate. I do not know of any credible diet/alternative therapies that have proven benefit for brain tumors. Your success against the tumor can be positively affected by establishing a team that you trust of doctors, support personnel and family members that will help you through this tough time.
I hope this has been helpful.
Before any thing, I would like to mention that the seizure history, the temporal lobe , and the young age of presentation in your husband's case are considered to have a favorable prognosis in most series.
About the treatment, almost none of the key issues have been studied well ( in well-designed prospective or randomized clinical trials) , so its difficult to specify the "conventional" treatment for these tumors, as the proper treatment needs to be individualized, based on several factors, including patient age, clinical presentation, tumor size and location, and tumor histology(the biopsy which is not going to be done on him).
Queted " Barker et al 1997; Ginsberg et al 1998 " (Patients with a presumed low-grade glioma based on MR imaging should undergo early stereotactic biopsy for several reasons:
(1) to verify that the lesion is in fact a tumor, rather than a non-neoplastic
process;
(2) to allow early identification of a grade 3 or grade 4 tumor and
(3) to differentiate astrocytoma from other low-grade gliomas (eg,
oligodendroglioma, ganglioglioma, dysplastic neuroepithelial tumor) as the
latter tumors carry different implications for management and outcome)
If the biopsy is risky, but did he/they do any special tests instead?
Like, MR spectroscopy (in gliomas generally shows increased choline peaks and decreased N-acetyl-aspartate (NAA) peaks) could also differentiation of low-grade versus high-grade gliomas, and a possible easy target for stereotactic biopsy (and/or a perfusion-weighted MR imaging is useful in identifying foci of increased relative cerebral blood volume that require close followup)
A FDG-PET scans, in Pilot studies suggest a possible correlation between survival outcome and the degree of uptake
Bob
He didn't mention the stereotactic biopsy nor the MR spectroscopy. I will ask about these. Are they fairly typical tests that are used in this case? I'm trying to figure out why they wouldn't have mentioned them. They also didn't mention the PET scan at all.
We are planning on getting our second opinion through the Cleveland Clinic and are hoping that they will have additional options.
No, these test are not typical especially in a none educational center (a small center), but as long as the biopsy is risky, then an alternative way should be tried to confirm and to follow up, especially if its a none invasive one!..
"We are planning on getting our second opinion through the Cleveland Clinic and are hoping that they will have additional options. " thats great if you don't mean an on line one? its better to get an actual appointement with a specialised center.
Hope you and your husband get over this soon
Bob
Thanks!
Leah
I'm a retired Neurologist and this is not my real name . I live in Canada now , but I know Cleveland clinic has had a very high reputation.
I'm very sure your husband will be locked after very well. Try to take every thing with you to the appointment especially the CD of the MR+ the reportI, and if still the st biopsy is not possible , then ask for a possible alternative way to confirm the diagnosis.... I'm not sure if the insurance could be a limiting factor these days? Hope not
Wish you the best
Bob
Our current neurologist told us that treatment at this point is not recommended and would rather wait to begin treatment when the tumor shows growth. From your experience and knowledge of current research, do you agree with this if they do end up confirming the diagnosis? It's hard to come to terms with that because we just want to try before it could become more aggressive.
I apologize that I keep asking more questions...you are the first person outside of our treatment team that has been able to answer questions for us!
Thanks!
Queted " Barker et al 1997; Ginsberg et al 1998 " (Patients with a presumed low-grade glioma based on MR imaging should undergo early stereotactic biopsy for several reasons:
(1) to verify that the lesion is in fact a tumor, rather than a non-neoplastic
process;
(2) to allow early identification of a grade 3 or grade 4 tumor and
(3) to differentiate astrocytoma from other low-grade gliomas (eg,
oligodendroglioma, ganglioglioma, dysplastic neuroepithelial tumor